A survey of observation units in the United States

Observation units have been proposed as a tool in lowering over-all health care costs and increasing the quality of care in outpatient facilities. Emergency department (ED) use of these units has been evaluated at single facilities but never at a national level. A survey of 250 facilities across the United States was performed to gather information about the observation unit phenomenon. Of the 250 hospitals in the survey group, 27% had operational observation or holding units and another 16% planned units within 1 year. A statistically significant increase in the use of these units was noted in nonteaching facilities when compared with their teaching counterparts. A trend toward higher use of observation units in suburban/urban settings was noted when compared with rural locations, although the difference was not statistically significant. Of the units in existence, 93% were located within the ED, staffed by emergency physicians, and administrated by the ED director. Most are staffed by ED nurses and ancillary help. No hospital had both an ED unit and a non-ED unit, and many units functioned as both holding and observation areas. The units are perceived to be beneficial in patient care and in lowering health care casts, although objective documentation to validate these beliefs is lacking. Further prospective research is needed to evaluate these units scientifically before broad recommendations can be made.     

Gender and the risk of falling: a sociological approach

AIM: This paper reports a grounded theory study of the influence of gender on older people's perceptions of their risk of falling and their actions to prevent future falls. BACKGROUND: The incidence and rates of falls among older people, including injurious falls, are of much international concern. The risk of falling remains a major concern for older people since it increases with age, with those aged 85 years and over at greatest risk. However, research using a sociological approach to the topic is limited. METHODS: An exploratory design, with grounded theory analysis, was used. Data were collected during 2001 through in-depth interviews with a convenience sample of 40 older people living in south east of England. FINDINGS: Two core categories emerged: gendered meanings of risk and gendered responsibility. The social construction of the meaning of the risk of falling and of participants' actions was gendered. Older men and women had specific ways of talking about their 'risk' and identifying the risk factors for falling. Older men perceived themselves as 'responsible' and 'rational' individuals who expected to reduce their own risk of falling. Older women's expectations of themselves and of their peers explained their tendency to blame themselves or others for their falls. These perceptions influenced the actions they took to prevent future falls. CONCLUSION: Nurses and other healthcare professionals need to take account of the gendered meanings attached to falling by older men and women when carrying out risk assessments and giving advice on fall prevention.     

Self-reported function and disability in late life – cross-cultural adaptation and validation of the Swedish version of the late-life function and disability instrument

Abstract

Purpose: To translate and perform a cross-cultural adaptation of the Late-Life Function and Disability Instrument (LLFDI) to Swedish, to investigate absolute and relative reliability, concurrent validity, and floor and ceiling effects within a Swedish-speaking sample of community-dwelling older adults with self-reported balance deficits and fear of falling. Method: Translation, reliability and validation study of the LLFDI. Sixty-two community-dwelling, healthy older adults (54 women and 8 men) aged 68–88 years with balance deficits and fear of falling performed the LLFDI twice with an interval of 2 weeks. Results: Test–retest agreement, intra-class correlation coefficient was very good, 0.87–0.91 in the LLFDI function component and 0.82–0.91 in the LLFDI disability component. The standard error of measure was small, 5–9%, and the smallest real difference was 14–24%. Internal consistency (Cronbach’s alpha) was high (0.90–0.96). Correlation with the SF-36 PCS and PF-10 was moderate in both LLFDI function, r?=?0.39–0.68 and r?=?0.35–0.52, and LLFDI disability, r?=?0.40–0.63 and 0.34–0.57, respectively. There was no floor or ceiling effects. Conclusion: The Swedish version of the LLFDI is a highly reliable and valid instrument for assessing function and disability in community-dwelling older women with self-reported balance deficits and fear of falling.

• Implications for Rehabilitation

• The Swedish LLFDI is a highly reliable and valid instrument for assessing function and disability in older women with self-reported balance deficits and fear of falling.

• The instrument may be used both in clinical settings and in research.

• The instrument is sensitive to change and a reasonably small improvement is enough to detect changes in a group or a single individual.

     

The risk of being fearful or fearless of falls in older people: An empirical validation

Purpose.?To investigate the risk of being fearful or fearless of falls in older people.

Methods.?Using a force plate, postural control in different sensory and rhythmic conditions was measured in 263 community-dwelling older people. Other assessments included fear of falling, and handgrip strength. Fall incidence was assessed at baseline and during a one-year follow-up period.

Results.?Logistic regression analysis revealed that increased lateral sway in near-tandem stance with eyes open (OR = 5.33; p < 0.01) and a worse performance on anteroposterior rhythmic weight shifts (OR = 0.65; p < 0.05) were related to falls. Univariate analyses revealed that older people with inappropriate high fear of falling according to their fall incidence had worse balance capacities on the rhythmic weight shifts (p < 0.05) but had similar static balance and physical capacities. Older people with inappropriate low fear of falling had a better hand grip (p < 0.05) but equally worse balance capacities than the comparison group.

Conclusions.?The results indicate the importance of lateral stability in relation to falls. They also suggest a substantial impact of inappropriate fear of falling on physical performance. Inappropriate high fear of falling may result in worse performance during dynamic balance tests, whereas older people with inappropriate low fear seem to overrate their capacities because of higher strength.     

开窗垂直板上液膜流动行为

液膜是规整填料中气 液接触的基本形式,壁面开孔、开窗是新型填料结构的组成部分。通过流场显示与高速摄影确定了开窗壁面上液膜流动的基本流型转变条件以及不同孔结构在流型转变中的作用。结果表明：过流的发生是液膜完成表面更新的主要途径;背流可以帮助板两侧完成液体交换。     

高龄患者跌倒风险因素分析及围术期护理干预

目的探讨围手术期高龄患者发生意外跌倒的风险因素及实施风险因素分级护理干预的效果。方法将2008年1月—2010年1月129例高龄住院患者(年龄≥65岁)作为对照组,分析患者发生意外跌倒的危险因素,并实施骨科常规护理;将2010年1月—2012年1月136例高龄患者(年龄≥65岁)作为观察组,对危险因素量化评分,前瞻性实施护理干预措施。比较2组患者风险事件发生率、护理服务满意度。结果观察组患者意外跌倒发生率为1.5%,显著低于对照组的7.8%;对照组患者满意度为82%,显著低于观察组的98%。结论在骨科病区进行意外跌倒风险因素分级管理,实施护理干预措施,不仅能够减少高龄患者住院期间意外跌倒不良事件的发生率,而且可以提高三级甲等医院的优质服务水平,值得临床推广应用。     

2010年浙江省慈溪市医院门诊伤害病例的流行病学分析

目的 了解浙江省慈溪市哨点监测医院门诊伤害病例的流行病学特征,为预防控制伤害提供依据.方法 选取慈溪市3家监测哨点医院的伤害监测资料,对2010年1月1日至12月31日门诊首诊的伤害病例进行分析.结果 2010年共报告46360例伤害病例,男女性别比1.85:1,平均年龄(33.3±18.2)岁.15～44岁组为...     

Environmental assessment and modification to prevent falls in older people

To assess the effectiveness of an environmental falls prevention intervention delivered by qualified occupational therapists or unqualified trained assessors. DESIGN: A pilot three‐armed randomized controlled trial. SETTING: Airedale National Health Service Trust catchment, North and West Yorkshire, England. PARTICIPANTS: Two hundred thirty‐eight community‐dwelling adults aged 70 and older with a history of falls in the previous year. INTERVENTION: Assessment and modification of the home environment of people at greater risk of falls. MEASUREMENTS: Fear of falling was the primary outcome measure, and an analysis of covariance was conducted on the area under the curve at 12 months. As a secondary outcome, falls were analysed using negative binomial regression. Quality of life and independence in activities of daily living (ADLs) were also measured. RESULTS: The intervention had no effect on fear of falling (P=.63). The occupational therapy group had significantly fewer falls than controls 12 months after the assessment (incidence rate ratio (IRR)=0.54, 95% confidence interval (CI)=0.36–0.83, P=.005). There was no significant effect on falls in the trained assessor group (IRR=0.78, 95% CI=0.51–1.21, P=.34). CONCLUSION: Environmental assessment had no effect on fear of falling. Environmental assessment prescribed by an occupational therapist significantly reduced the number of falls in high‐risk individuals whereas that prescribed by a trained assessor did not. Further research in other settings is needed to confirm this, to explore the mechanisms, and to estimate cost‐effectiveness.